CONSERVATIVE SURGERY FOR RECURRENT OR PERSISTENT CARCINOMA OF THE CERVIX FOLLOWING IRRADIATION - IS EXENTERATION ALWAYS NECESSARY

Between 1960 and 1988, 47 patients had conservative surgery for postra diation recurrent or persistent cervical carcinoma. Forty-two patients with nonmetastatic disease and available follow-up information were d ivided into 3 groups based on the extent of disease and type of surgic al procedure. Group 1 contained 13 patients with smaller tumors prior to radiation (FIGO Ib and IIa), and recurrent or persistent disease co nfined to the cervix and/or vaginal vault. Group 2 consisted of 20 pat ients presenting with more advanced disease than those in Group 1, at the time of either radiation or surgery. Surgical resection of disease was accomplished in both Groups 1 and 2 by either radical vaginal or abdominal hysterectomy. The 8 patients in Group 3 required extended We rtheim operations to encompass locally advanced disease involving the bladder base and/or parametrium. One patient could not be categorized. The 5-year estimated relapse-free survivals for each group were 84, 4 9, and 25%, respectively. The relapse-free survival of Group 1 was sig nificantly better (P = 0.003) than that of Group 3. Major complication s occurred in 4 patients belonging to Group 1 (31%), 10 in Group 2 (50 %), and 6 (including two treatment-related deaths) in Group 3 (75%). T he most common complication was fistula formation in 11 patients (26%) . Radical hysterectomy can be offered as an alternative to exenteratio n in carefully selected patients. (C) 1994 Academic Press, Inc.